A comparison of two modes of delivery for epidural analgesia in labor: epidural anesthesia versus combined spinal-epidural anesthesia. A study was carried out at Queen Rania Maternity Hospital in 1990 to evaluate and compare the effects of two modes of epidural analgesia in labor. Epidural anesthesia (EA) is the most popular technique used worldwide. A combined spinal-epidural anesthesia (CSEA) procedure involves the administration of spinal anesthetic prior to a labor epidural, therefore allowing for continuous spinal anesthesia combined with epidural analgesia. The study was designed to compare the effects of these two modes of analgesia on the duration of labor and side effects, the quality of analgesia, maternal and fetal outcome. This is a prospective, randomized, double blind study of 135 women in labor and their babies. Labor was induced in 136 women using oxytocin infusion and they were randomly divided into two groups. EA group patients received only epidural analgesia for labor while CSEA group patients received an epidural followed by spinal anesthesia, and were then given combined spinal-epidural analgesia. The quality of pain relief in the EA group was evaluated as 'excellent' for 56.1%, 'good' for 40.6% and 'fair' for 3.2% of the patients, while the quality of analgesia in the CSEA group was 'excellent' in 65.5%, 'good' in 32.4% and 'fair' in 2.1% of the patients. Although there was no difference in the duration of labor between the groups, the mean duration of the first and second stage of labor was significantly shorter in the CSEA group. Neonatal outcome was assessed as Apgar score, need for neonatal resuscitation and admission to the neonatal intensive care unit. The cesarean section rate was significantly higher in the CSEA group (23% versus 7%). It is concluded that for patients with low or intermediate epidural dose requirement, CSEA is not a better method of analgesia in labor. Both EA and CSEA techniques offer satisfactory analgesia, though pain relief is better in CSEA group. There were no cases of maternal hyperalgesia, fetal distress or complications associated with epidural analgesia in either group. The rate of cesarean section in the CSEA group was higher due to the fact that some of the patients needed augmentation of labor with oxytocin.